Washington, Aug 26 (ANI): Prostate cancer patients, who also suffer
from heart conditions, have increased death risk if they undergo hormone
therapy, revealed a study led by an Indian-origin scientist.

Dr. Akash Nanda, from Boston, has found that when men with coronary
artery disease-induced congestive heart failure or heart attack receive
hormone therapy before or along with radiation therapy for treatment of
prostate cancer, they have an associated increased risk of death.

His study report says that patients with localized prostate cancer
have several options available for treatment, including the use of
brachytherapy (treatment in which radioactive seeds are implanted in the
prostate), both as monotherapy and in conjunction with external beam
radiation therapy.

Neoadjuvant (treatment that is given before or with the primary
treatment) hormonal therapy (HT) is used as a means for prostate gland
cytoreduction (decrease in number of cells, as in a tumor) in order to
eliminate pubic arch (an arch formed by the pubic bones) interference
and improve the ability to perform brachytherapy.

Previous research has suggested that "hormonal therapy, when
added to radiation therapy (RT) for treating unfavorable-risk prostate
cancer, leads to an increase in survival except possibly in men with
moderate to severe comorbidity [co-existing illnesses]. However, it is
unknown which comorbid conditions eliminate this survival benefit,"
the authors write.

Dr. Nanda his colleagues assessed whether neoadjuvant HT use in men
with prostate cancer treated with brachytherapy affects the risk of
all-cause death of men with known coronary artery disease-induced
conditions, including congestive heart failure and heart attack.

The researchers conducted the study on 5,077 men (median [midpoint]
age, 69.5 years) with localized or locally advanced prostate cancer who
were treated with or without a median of 4 months of neoadjuvant HT
followed by RT between 1997 and 2006 and were followed up until July
2008.

They found that during the study period, 419 men died, out of
which, 200 had no underlying comorbidity, 176 had one coronary artery
disease risk factor, and 43 had a history of known coronary artery
disease resulting in congestive heart failure or heart attack.

The researchers said that the analyses of the data indicated that
"when considering comorbidity groups separately, neoadjuvant HT use
was not associated with an increased risk of all-cause mortality in men
with no comorbidity or a single coronary artery disease risk factor
after median follow-ups of 5.0 years and 4.4 years, respectively."

But, for men with coronary artery disease-induced congestive heart
failure or heart attack, after a median follow-up of 5.1 years,
neoadjuvant HT use was associated with nearly twice the risk of
all-cause mortality.

"The clinical significance of this finding is that for men
with favorable-risk prostate cancer and a history of congestive heart
failure or myocardial infarction who require neoadjuvant HT solely to
eliminate pubic arch interference, alternative strategies such as active
surveillance or treatment with external beam radiation therapy or
prostatectomy should be considered.

"However, for men with unfavourable-risk prostate cancer who
require HT in addition to radiation therapy to take advantage of its
survival benefit, appropriate medical evaluation prior to initiation
should facilitate clinicians in balancing the relative risks against the
benefits of HT use," said the researchers

The study has been published in the latest issue of JAMA. (ANI)

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